Does Fracture Location and Patient Comorbidity Influence Opioid Requirements in Tibial and Ankle Fractures?

Abstract Aim Opioid requirement in post-operative rehabilitation is an important area in orthopaedic surgery, with no large UK-based studies. Guidelines should reflect anticipated patient requirements. Our study explores the characteristics predisposing surgically managed tibial fracture patients to increased opioid requirements. Method All tibial fractures from 2015-2022 at a Major Trauma Centre were evaluated. 1890 patients were included. Post-operative opioid prescriptions in the 1st post-operative year were calculated every month up to 6 months and then from the 7th-12th month. Overall prescribed Morphine Milligram Equivalents (MME) “strength” and days with at least one opioid prescription (“coverage”) were calculated. Demographic, fracture location and various comorbidities were included in the multivariate modelling. Results Compared to the tibial average, plateau and Pilon fractures had x1.51 and x1.20 times the strength in the first year, with significance at every sub-interval (p<0.01) and ankle fractures had x0.756, significance at every individual time-interval (p<0.05). For relative strength and coverage, for all time intervals, obesity, pulmonary disease, and drug abuse were associated with higher opioid requirements (p<0.05). Age, Charleston Comorbidity Index (CCI) and BMI were each positively associated with coverage in each of the first 3 months, with age and CCI associated with strength in 1st month (p<0.05). Conclusions Our study begins to elucidate a range of patient factors that can predispose to increased opioid usage in total strength and overall coverage. This, begins to construct an evidence-based tool for clinicians to base opioid prescriptions, manage patients effectively, and guide opioid stewardship.